title: Nicorandil associated colonic ulceration: case series of an increasingly recognized complication.
abstract: BACKGROUND
  Nicorandil is widely accepted in the therapeutic armamentarium of ischemic heart disease and, although nicorandil-induced oral and anal ulcerations have been established in the literature, only five cases have reported the possibility of nicorandil-induced ulceration elsewhere in the gastrointestinal tract. There have been recent case reports which have suggested the possible causative association between nicorandil and colonic ulceration, either in isolation or in combination with anal ulceration.
  
  
  METHODS
  We report a case series of eight patients prescribed with nicorandil therapy presenting with gastrointestinal symptoms and subsequently diagnosed with colonic ulceration on colonoscopy.
  
  
  RESULTS
  Eight patients were identified (five female, three male). Colonoscopic findings varied from solitary to multiple colonic ulcers. No concomitant oral or anal ulcerations were noted in these patients. Biopsies from the ulcers showed only non-specific inflammation. Cessation of nicorandil therapy resulted in resolution of symptoms and complete healing of colonic ulcers.
  
  
  CONCLUSIONS
  Nicorandil therapy appears to be an emerging etiology in the development of idiopathic colonic ulceration and therefore should be considered as a differential diagnosis in a selected group of patients.
authors.affiliation: Department of Gastroenterology, Downe Hospital, South Eastern Health and Social Care Trust, 2 Struell Wells Road, Downpatrick, BT30 6RL, Northern Ireland, UK. bee9669@yahoo.com
authors.forename: Bee C
authors.initials: BC
authors.lastname: Lee
authors.forename: Patrick B
authors.initials: PB
authors.lastname: Allen
authors.forename: Grant R
authors.initials: GR
authors.lastname: Caddy
authors.forename: Inder
authors.initials: I
authors.lastname: Mainie
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D003108:Colonic Diseases / Q000139:chemically induced* / Q000175:diagnosis; D003113:Colonoscopy; D005260:Female; D006801:Humans; D008297:Male; D017202:Myocardial Ischemia / Q000188:drug therapy; D020108:Nicorandil / Q000009:adverse effects* / Q000627:therapeutic use; D016896:Treatment Outcome; D014456:Ulcer / Q000139:chemically induced*; D014665:Vasodilator Agents / Q000009:adverse effects* / Q000627:therapeutic use
chemical_list: D014665:Vasodilator Agents; D020108:Nicorandil